Dd Form 2656 10 PDF Details

When filling out a Dd Form 2656-10, you need to be as thorough as possible. This form is used by the Department of Defense to document Casualty Status Inquiries and Casualty Reports. In order to complete this form accurately, you will need information about the casualty such as full name, social security number, and date of birth. You will also need to know the circumstances surrounding the casualty. Providing all of this information will help ensure that your report is processed quickly and accurately.

QuestionAnswer
Form NameDd Form 2656 10
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names2656 10 sbp, how to form sbp, dd form 2656 10 survivor benefit plan, form deemed dfas

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SURVIVOR BENEFIT PLAN (SBP) FORMER SPOUSE

REQUEST FOR DEEMED ELECTION

OMB No. 0704 - 0569 OMB approval expires 20230731

The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod- informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. Chapter 73, subchapters II and III Survivor Benefit Plan; DoD Instruction 1332.42, Survivor Annuity Program Administration; DoD Financial Management Regulation, Volume 7B, Chapter 43; and E.O. 9397 (SSN), as amended.

PRINCIPAL PURPOSE(S): Used by a former spouse to deem an election for Former Spouse SBP coverage or Former Spouse Reserve Component (RC) SBP.

ROUTINE USE(S): To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.C. Section 1450(f)(3), regarding SBP or RC-SBP coverage. The

System of Record Notice (SORN) T7347b is published at: https://www.federalregister.gov/documents/2009/01/07/E9-41/privacy-act-of-1974-systems-of-records

DISCLOSURE: Voluntary; however failure to provide requested information within one year of the date of the court order which requires former spouse SBP coverage will result in denial of former spouse SBP or RC-SBP coverage.

INSTRUCTIONS

GENERAL.

1.Read these instructions carefully before completing the form. Please print legibly.

2.You must advise the finance center (see Item 3 below for address) of any changes to marital status, your correspondence address, or changes to your financial institution.

3.Mail your election (it is strongly recommended that you send via certified or registered mail) to the appropriate Uniformed Service designated agency. The Uniformed Services' designated agents are:

(a)ARMY, NAVY, AIR FORCE and MARINE CORPS: Defense Finance and Accounting Service Garnishment Law Directorate, Post Office Box

998002, Cleveland OH 44199-8002

(b)COAST GUARD: Commanding Officer (LGL), USCG Pay and Personnel Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591

(c)PUBLIC HEALTH SERVICE: Commissioned Corps Headquarters, Compensation Branch, 1101 Wooten Parkway, Suite 300, Rockville, MD 20852

(d)NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION: Same as U.S. Coast Guard.

4.This form must be submitted within one year of the date of the court order or written agreement authorizing former spouse coverage.

SECTION I - MEMBER IDENTIFICATION

1.MEMBER NAME (Last, First, Middle Initial)

2.SSN or DoDID

3a. BRANCH OF SERVICE

Army

Navy

Air

Force

 

 

Marine Corps

NOAA

Coast Guard

 

USPHS

b. (X ONE)

Active

National

Guard

Reserve

4. IS MEMBER RETIRED? YES

NO

5. IF KNOWN, ENTER DATE OF MEMBER'S RETIREMENT (YYYYMMDD)

SECTION II - FORMER SPOUSE IDENTIFICATION

6a. FORMER SPOUSE NAME (as it appears on court order) (Last, First, Middle Initial)

7. SSN or DoDID

6b.CURRENT NAME (Last, First, Middle Initial)

8.ADDRESS (Include ZIP Code)

9. DATE OF BIRTH (YYYYMMDD)

10.TELEPHONE NUMBER

11. EMAIL ADDRESS

12. MARRIAGE HISTORY

a. DATE MARRIED TO MEMBER

(Listed in Item 1 above) (YYYYMMDD)

b. DATE OF DIVORCE (YYYYMMDD)

c. ARE YOU CURRENTLY MARRIED?

d. IF YES, DATE OF CURRENT MARRIAGE (YYYYMMDD)

YES

NO

DD FORM 2656-10, JULY 2020

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 2

 

MEMBER NAME (Last, First, Middle Initial)

SSN or DODID

SECTION III - AUTHORITY TO REQUEST DEEMED SBP ELECTION

13. IS ELECTION MADE PURSUANT TO REQUIREMENTS OF A COURT ORDER (If 'Yes', attach a copy of the associated

YES

NO

divorce agreement and court order)?

 

 

 

 

 

14. IS ELECTION BEING MADE PURSUANT TO WRITTEN AGREEMENT AS PART OF OR INCIDENT TO A PROCEEDING

 

 

OF DIVORCE, DISSOLUTION, OR ANNULMENT THAT HAS BEEN INCORPORATED IN, RATIFIED, OR APPROVED BY A

YES

NO

COURT ORDER? (If `Yes', attach a copy of the written agreement and court order).

 

 

 

 

 

NOTE: IF YOU ANSWERED `NO' TO BOTH ITEM 13 AND ITEM 14, ABOVE, STOP, YOU ARE NOT ELIGIBLE TO REQUEST A DEEMED SBP ELECTION.

SECTION IV - DEPENDENT CHILDREN INFORMATION

15.WAS CHILD COVERAGE ALSO COURT-ORDERED OR REQUIRED BY A WRITTEN AGREEMENT? (If you answered 'NO' to item 15, do not complete item 16).

YES

NO

16.LIST DEPENDENT CHILDREN REQUIRED TO BE COVERED BY COURT ORDER/WRITTEN AGREEMENT. (If a court awarded former spouse and child(ren) coverage, list all of the children of your marriage to the member. In block d., list that child's relationship to the member and with you. For example, 'my daughter and his stepson')

a. NAME (Last, First, Middle Initial)

b. DATE OF BIRTH(YYYYMMDD)

c. SSN

d.RELATIONSHIP

(Son, daughter, stepson, etc.)

(e) DISABLED?

(If 'YES', provide additional information in Item 17. REMARKS)

17.REMARKS (Use this space to further explain any item if necessary. Reference by item number.)

SECTION V - FORMER SPOUSE SIGNATURE

18. SIGNATURE

19. DATE SIGNED (YYYYMMDD)

DD FORM 2656-10, JULY 2020

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 2

 

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1. Begin completing your dd form 2656 10 survivor benefit plan with a group of essential fields. Gather all of the important information and make certain nothing is left out!

dd2656 10 completion process described (step 1)

2. Once the last part is filled out, go to type in the applicable details in all these - MARRIAGE HISTORY, a DATE MARRIED TO MEMBER Listed in, b DATE OF DIVORCE YYYYMMDD, c ARE YOU CURRENTLY MARRIED, d IF YES DATE OF CURRENT MARRIAGE, YES, DD FORM JULY, PREVIOUS EDITION IS OBSOLETE, and Page of.

How to fill out dd2656 10 portion 2

3. This next part will be focused on MEMBER NAME Last First Middle, SSN or DODID, SECTION III AUTHORITY TO REQUEST, IS ELECTION MADE PURSUANT TO, IS ELECTION BEING MADE PURSUANT, YES, YES, NOTE IF YOU ANSWERED NO TO BOTH, SECTION IV DEPENDENT CHILDREN, WAS CHILD COVERAGE ALSO, If you answered NO to item do not, YES, LIST DEPENDENT CHILDREN REQUIRED, a NAME Last First Middle Initial, and b DATE OF BIRTHYYYYMMDD - fill out these empty form fields.

dd2656 10 conclusion process detailed (portion 3)

4. It is time to fill out this next part! Here you'll get all these REMARKS Use this space to further fields to fill in.

Step number 4 in completing dd2656 10

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Completing segment 5 of dd2656 10

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